A Prospective Study of Endoscopic Radio-Frequency Non-Ablative (STRETTA) Therapy for Gastrooesophageal Reflux Disease: Early UK Experience

Y K S Viswanath, Mr1, Humza Numan, Mr1, Dariush Kamali1, Anjan Dhar, Dr2, Sibby Punnoose, Dr2. 1James Cook University Hopsital, 2Darlington and Bishop Auckland Hopsitals

Introduction: Radiofrequency non-ablative application (RFA) – STRETTA, is considered appropriate therapy for patients with gastrooesophageal reflux disease (GORD) (SAGES 2013), producing symptomatic relief in those patients (UK NICE guidance 2013). This is the first UK study to present our early experience of patients undergoing RFA for GORD.

Methods and procedures: A prospective study on all patients who underwent RFA at our institute, October 2014 to August 2015. All patients underwent upper gastrointestinal endoscopy and barium meal as part of preoperative work up. Data presented as median (interquartile range, IQR).

Results: Over the 10 month period, 19 patients underwent RFA therapy for GORD. The median (IQR) age was 62 (52-65) years with 12/19 (63%) patients were females. All patients received information sheet explaining the procedures 4 weeks in advance. Four patients have had a previous antireflux surgery. All patients were dissatisfied with their GORD prior to the RFA with a median (IQR) of pre-RFA heartburn, dysphagia, and regurgitation scores of 4 (3.5-4), 2 (0-4), and 4 (3-4), respectively, (0=no symptoms, 1=symptoms noticeable but not bothersome, 2= symptoms bothersome but not every day, 3=symptoms bothersome every day, 4=symptoms affect daily activity, and 5=incapacitating symptoms). Six out of the nineteen patients had evidence of ≤2cm hiatus hernia on pre-RFA barium meal. Eight patients underwent their procedure under general anaesthesia while 11 had conscious sedation.

All patients were treated on a daycase basis. Endoscopic RFA was delivered at all peri- gastrooesophageal junction 6 levels in all patients with a median (IQR) of 50 (44-54), out of possible 56, treatment points achieving more than 30 seconds cycle. No postoperative complications were encountered. At a median (IQR) follow up of 4 (2-6) months, 17/19 (90%) patients were satisfied with the outcome, with the median (IQR) post-RFA heartburn, dysphagia, and regurgitation scores of 1 (0-1), 0 (0-1), and 0 (0-2), respectively.

Conclusions: Therapeutic endoscopic RFA (STRETTA) is feasible and safe in the treatment of symptomatic GORD. In short term, it achieves symptomatic relief in the majority of patients. In patients with poor response to medical therapy, it can be considered as an alternative option to surgery in those who are unfit for surgical intervention. Long term follow up is essential to appraise the durability of these favourable outcomes in our population.

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